Individual provider Active NPI

Jose Q Concepcion, MD

  • Pediatrics Physician
  • Brooklyn, NY
National Provider Identifier
1194796714
Registry record updated Sep 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
145124 Issued in NY
Practice address
1620 E New York Ave
Howard Houses
Brooklyn, NY 11212-6861
Phone
(718) 385-3690
NPI assigned
Jan 31, 2006
Last updated
Sep 2, 2010By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 2, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 145124 NY Primary

Addresses

Primary practice location

1620 E New York Ave
Howard Houses
Brooklyn, NY 11212-6861

Mailing address

137 Barlow Dr
Brooklyn, NY 11234
Phone (718) 763-1042

Other identifiers 1

IdentifierTypeStateIssuer
00643370MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170117000351 NY Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 3577721760

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
145124NYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Empress Ambulance Service LLC Past Accepting new patients
Lifespire, Inc. Past Accepting new patients
Lifespire, Inc. Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283385600000",
    "number": "1194796714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "137 BARLOW DR",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11234",
            "telephone_number": "718-763-1042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 E NEW YORK AVE",
            "address_2": "HOWARD HOUSES",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112126861",
            "telephone_number": "718-385-3690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONCEPCION",
        "first_name": "JOSE",
        "middle_name": "Q",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-31",
        "last_updated": "2010-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "145124",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00643370",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.